ARTERIJSKA HIPERTENZIJA U BOLESNIKA NA KRONIČNOJ HEMODIJALIZI

DRAŠKO PAVLOVIĆ, BRANKO HEINRICH, DANIELA GERMIN-PETROVIĆ, NIKOLA PAVLOVIĆ

Arterijska hipertenzija jedan je od najčešćih uzroka kroničnog zatajenja bubrega ijedna od najčešćih komplikacija u bolesnika na kroničnoj hemodijalizi. Cilj rada bio je ispitati prevalenciju arterijske hipertenzije u bolesnika na kroničnoj hemodijalizi, te način liječenja. U ispitivanje je bilo uključeno 168 bolesnika (86 žena i 82 muškarca) iz tri centra za dijalizu, prosječne dobi 62,4±12,9 godina. Arterijska hipertenzija definirana je kao vrijednost tlaka neposredno prije hemodijalize >140/90 mmHg ili niža ako je bolesnik bio na antihipertenzivnoj terapiji. Prije početka kroničnog programa hemodijalize arterijska hipertenzija bila je poznata u 139 bolesnika (81%). Bolesnici su na hemodijalizi bili 52,5±45,17 mjeseci. Svi su bolesnici dijalizirani tri puta na tjedan, prosječno 11,7 (od9do 13,5) sati na tjedan. Tjelesna težina ispitanih bolesnika bila je 68,4±15,8 kg, a porast težine između dijalize bio je 2,9±1,1 kg. Arterijska hipertenzija registrirana je u 141 bolesnika (84%), prosječna vrijednost tlaka prije hemodijalze u tih bolesnika bila je 157,3±17,3/85,2±8 mmHg. Prosječna vrijednost tlaka ostalih bolesnika bila je 132,6±8,2/78,3±10,3 mmHg. Bolesnici su liječeni raznim antihipertenzivnim lijekovima, 37 bole­snika bilo je na monoterapiji, a ostali su bili na kombiniranoj terapiji (2–4 antihipertenziva). Najčešće rabljeni lijekovi su kalcij ski antagonisti (95 bolesnika, 67%), ACE-inhibitori 33% (47 bolesnika), β-blokatori 20% (29 bolesnika), ATl-inhibitori i a-blokatori u 25 bolesnika (17%), diuretici uli (7%), u 9 (6%) bolesnika rabljeni su lijekovi s centralnim djelovanjem, kao i a+ β-blokator. Prevencija i liječenje arterijske hipertenzije poseban su problem u bolesnika na hemodijalizi. Nažalost još ne postoje smjernice ni glede optimalnog načina mjerenja arterijskog tlaka u ovih bolesnika, ni optimalnih vrijednosti arterijskog tlaka kao ni prvog lijeka izbora ili optimalne kombinirane terapije. Možda su i zbog toga kardiovaskularni pobol i smrtnost ovih bolesnika veliki.

Summary. Arterial hypertension is one of the most frequent causes of chronic kidney failure but also one of most frequent complications in patients on long-term haemodialysis. The aim of this work is to investigate the prevalence of arterial hyper- tension in long-term haemodialysis patients, and methods for treating it. A total of 168 patients (86 women and 82 men aver- age age 62.9±12.9 years) from three dialysis centers were included in this study. Arterial hypertension was defined as blood pressure immediately before hemodialysis >140/90 mmHg or less if the patient has been on anti-hypertensive therapy. Before the beginning of a long-term hemodialysis program arterial hypertension was registered in 139 (81%) patients. The patients were on haemodialysis 52.5±45.17 months. All patients were dialyzed three times per week, an average of 11.7 hours per week (9 to 13.5 hours). Body weight of the patients was 68.4±15.8 kg, and weight gain between dialysis treatments was 2.9±1.1 kg. Arterial hypertension was recorded in 141 patients (84%), i.e. average blood pressure before haemodialysis in all patients was 157.3±17.3/85.2±8 mmHg. The average blood pressure of the remaining patients was 132.6±8.2/ 78.3±10.3 mmHg. The patients were treated with a variety of anti-hypertensive drugs. Thirty-seven patients were on monotherapy, while the others were on combined treatment (2–4 antihypertensive drugs). The most frequently used antihypertensive drugs were calcium channel blockers (95 patients, or 67%), ACE inhibitors (47 patients, or 33%), b-blockers (29 patients, or 20%), angiotensin II receptor blockers and a-blockers (25 patients, or 17%), diuretics (11 patients, or seven percent), and nine patients (6%) received central agents or drugs wich acted like an a+b blocker. Preven- tion and treatment of arterial hypertension is a special problem for haemodialysis patients. Unfortunately, there are still no guidelines for the optimal method of measuring blood pressure in these patients, or optimal values of arterial blood pressure, the first drug of choice or optimal combination of therapies. Perhaps because of this cardiovascular morbidity and mortality among these patients is high.